PURPOSE:Corticosteroids have not been shown to be effective in the treatment of idiopathic pulmonary fibrosis (IPF), however they are widely prescribed in this population. It is not known how many patients are treated with corticosteroids at the time of diagnosis, what impact treatment guidelines published in 2000 have had on initial treatment, and what effect the combined use of steroid sparing agents has on the dose of corticosteroids prescribed.
METHODS:A retrospective cohort study of patients with a diagnosis of IPF was conducted using The Health Improvement Network (THIN) database from the United Kingdom. Demographic, diagnostic and prescription information for all patients was recorded and analyzed. Initiation of therapy was defined as a prescription within 30 days of diagnosis for either corticosteroids alone or in combination with azathioprine or cyclophosphamide.
RESULTS:A total of 1132 patients with IPF were analyzed. In the total cohort, 27.1% (CI 24.5–29.7%) of patients received corticosteroids within 30 days of diagnosis. The mean initial daily dose was 26.1 mg of prednisolone (sd 17.45 mg). Of patients who received a prescription for corticosteroids, 17.6% (CI 13.3–21.9%) also received a prescription for a steroid sparing agent. The daily dose of corticosteroids prescribed with steroid sparing agents was not significantly different than that prescribed as monotherapy (23.5 vs. 26.6 mg/d, p=0.23). The proportion of patients that received corticosteroids did not change after the 2000 guidelines (28.6% before vs. 25.8% after, p=0.30), however the proportion of patients treated with combination therapy did increase significantly (9.3% vs 25.6%, p=0.0002).
CONCLUSION:A minority of patients in this cohort were treated with corticosteroids at the time of diagnosis. While the total use of corticosteroids did not change after the publication of IPF treatment guidelines, the use of combination therapy increased significantly. The use of combination therapy did not impact the dose of corticosteroids prescribed.
CLINICAL IMPLICATIONS:Clinical observation alone after initial diagnosis with IPF is common. When corticosteroid treatment is initiated, the use of combination therapy with azathioprine or cyclophosphamide is infrequent.
DISCLOSURE:Jeffrey Munson, No Financial Disclosure Information; No Product/Research Disclosure Information